‘I AM NOT A MONSTER': THE LINGUISTIC STIGMA OF BORDERLINE PERSONALITY DISORDER.

"Borderline Personality Disorder is arguably the most distressing disorder amongst the DSM diagnoses for all involved. Although psychiatric labelling can be validating it is often stigmatising. Due to the nature of BPD, people living with the disorder (PBPD) tend to be marginalized and discriminated against. A quick and random review of the World Wide Web (including a selection of popular social media platforms) reveals a common linguistic theme in describing BPD. PBPD are ‘toxic’, ‘difficult’ and ‘manipulative. Other labels, more diagnostically - oriented see PBPD as the ‘PDs’ or ‘the borderlines’. These also carry negative connotations of the inner and outer groups - ‘us’ vs ‘them’. Given the nature of the labels, recovery for PBPD is often dubious. One might think - ‘I am a monster anyway’, a classic example of cognitive dissonance. The language used in clinical practice as well as out of it is a powerful weapon. Some might poetically describe BPD as a lethal cocktail of blended psychopathologies with the ingredients including chronic suicidality, abandonment and intermittent lucidity to name a few. Of note, externalising such pathologies in an adaptive way is almost a fantasy for the therapy team. A more user friendly descriptive diagnosis is ‘difficulty in emotion regulation’. However, probably the most accurate ‘label’ of BPD for PBPD is ‘living in acute pain’. The current climate and the uncertainty surrounded the ongoing COVID-19 pandemic has meant a significantly increased risk not only in symptoms remission but also in the increase in cyber-bullying and suicidality rate. The pandemic has also put a halt to the Participant and Public Involvement in the evidence based practice. Linguistic shift in reducing stigma is essential and of immediate need."

Low dose oral ketamine treatment in chronic suicidality: An open-label pilot study

Recently, low-dose ketamine has been proposed as a rapid-acting treatment option for suicidality. The majority of studies to date have utilised intravenous (IV) ketamine, however, this route of administration has limitations. On the other hand, oral ketamine can be administered in a range of settings, which is important in treating suicidality, although studies as to safety and feasibility are lacking. n = 32 adults (aged 22–72 years; 53% female) with chronic suicidal thoughts participated in the Oral Ketamine Trial on Suicidality (OKTOS), an open-label trial of sub-anaesthetic doses of oral ketamine over 6 weeks. Participants commenced with 0.5 mg/kg of ketamine, which was titrated to a maximum 3.0 mg/kg. Follow-up assessments occurred at 4 weeks after the final dose. The primary outcome measure was the Beck Scale for Suicide Ideation (BSS) and secondary measures included scales for suicidality and depressive symptoms, and measures of functioning and well-being. Mean BSS scores significantly reduced from a high level of suicidal ideation at the pre-ketamine (week 0) timepoint to below the clinical threshold at the post-ketamine (week 6) timepoint. The proportion of participants that achieved clinical improvement within the first 6 weeks was 69%, whereas 50% achieved a significant improvement by the follow-up (week 10) timepoint. Six weeks of oral ketamine treatment in participants with chronic suicidality led to significant reduction in suicidal ideation. The response observed in this study is consistent with IV ketamine trials, suggesting that oral administration is a feasible and tolerable alternative treatment for chronic suicidality.